Basic Information
| Provider Information | |||||||||
| NPI: | 1790349603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOGUE | ||||||||
| FirstName: | JANENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 N 16TH ST STE 316 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850061266 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 S MERIDIAN STE A&B | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983716995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532355216 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2019 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | N | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101Y00000X | CG60918744 | WA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.